PMS is a condition that is so widely accepted as normal or expected, that it has its share of nicknames, the most popularly perhaps being “That Time of the Month.”

Meanwhile, there is nothing amusing about a problem that can often be avoided simply with lifestyle awareness and hormone balance.

When a woman is under chronic stress, PMS is at its worst, often making her miserable.

moleculePremenstrual syndrome, or PMS, refers to a collection of symptoms that occur sometime between ovulation and the onset of menstruation. The range of women’s experience with PMS is wide, with symptoms that are either mild, or not noticeable, to severe symptoms that require bed rest and days missed from work.

Estimates of the percentage of women affected by PMS vary widely. According to the American College of Obstetricians and Gynecologists, at least 85 percent of menstruating women have at least one PMS symptom as part of their monthly cycle.1

PMS Symptoms
While there are a wide variety of symptoms that could be considered PMS symptoms, most women experience these kinds of changes:

  • Physical: Back pain, breast tenderness, acne, stomach ache, cramping, bloating, diarrhea and headaches.
  • Mental/Psychological: Changes in appetite (including food cravings), sleep problems, anxiety, mood swings, and depression.

The most severe of the symptoms is referred to as premenstrual dysphoric disorder (PMDD), which affects from around 3 to 8 percent of menstruating women 2. Women with PMDD experience a severe enough depression to interfere with their activities of daily living (work, social or family life).

What Causes PMS?
womanWhile it is hard to believe, scientists still don’t know what causes the symptoms of PMS. It is generally believed that the symptoms of PMS result from rollercoaster-like changing of hormones levels during a monthly cycle. Hormonal levels dramatically rise and fall over the course of a month. The largest spike in estrogen occurs right before ovulation, followed by a peak in luteinizing hormone (LH). These peaks are then followed by a peak in progesterone and then follicle stimulating hormone (FSH). FSH starts the process over again and estrogen begins to rise.

While scientists know that the hormones fluctuate during a monthly cycle, what they don’t know is how these fluctuations create the symptoms that are typical in PMS. Some studies show that the fluctuating hormones can affect the chemical messengers in the brain. One recent study has shown that receptors for serotonin (a brain chemical messenger that plays a role in mood) are increased by estrogen, but then decline when estrogen is absent. This work may help us to understand the link between depression and lowering estrogen levels 3. A similar study showed that estrogen can affect dopamine (another brain chemical messenger) levels as well, which may impact not only mood, but also memory and cognitive states.4

Much more research needs to be done, but nothing will replace a common sense approach to stress.

What to do about Premenstrual Syndrome
Medical Approach
Remember, you didn’t get sick because you were not taking prescription drugs…

  • Antidepressants: Antidepressant medications including Prozac, Paxil, Zoloft and others have been shown to help with the symptoms of PMS including reducing fatigue, sleep problems, and food cravings. They have also been shown to improve symptoms of PMDD and cause addiction.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): These medications, many available over-the-counter, have been used to reduce the cramping and breast discomfort associated with PMS.
  • Oral Contraceptives: Many women report a change in their PMS symptoms when they are put on birth control pills. Depo-Provera (an injection) has been used to help women with PMDD, but can also make symptoms such as increased appetite, headache, weight gain, and depressed mood even worse.

Integrative Approach to Premenstrual Syndrome

  • Functional Lab Testing: As with any health condition or prevention plan, one should devote resources towards doing as much lab testing as possible to identify dysfunction. Salivary and blood hormone testing for measuring hormone levels are available from Biohealth.
  • Bioidentical Hormone Replacement: Hormones that match your natural hormones are called Bioidentical Hormones. These hormones typically have fewer side effects and improve symptoms better than synthetic hormones.5 To find a doctor who can help balance your hormones, visit this page.
  • Diet: A diet that includes plenty of fresh fruits and vegetables is essential for someone with PMS (not to exclude the rest of us). The diet should also be low in fat, sugar, caffeine, and salt.
  • Exercise: Regular aerobic exercise is a great recommendation for people with PMS and especially for women with PMDD. 6
  • Vitamins and Minerals: Magnesium 7 and calcium 8 have been shown to improve symptoms of PMS, especially cramping (see Cal-Mag). Vitamin E has been shown to reduce breast tenderness, fatigue, nervous tension and insomnia.9 Vitamin B6 can help improve issues with fluid retention, irritability and mood swings.10

1 American College of Obstetricians and Gynecologists : Premenstrual Syndrome Patient Handout. Accessed on 8/8/2009.
2 U.S. Department of Health and Human Services. Premenstrual Syndrome: FAQ. . Accessed 8/2/2009.
3 Amin Z, Canli T, Epperson CN. Effect of estrogen-serotonin interactions on mood and cognition. Behav Cogn Neurosci Rev. 2005 Mar;4(1):43-58..
4 Fink G, Sumner BE, Rosie R, Grace O, Quinn JP. Estrogen control of central neurotransmission: effect on mood, mental state, and memory. Cell Mol Neurobiol. 1996 Jun;16(3):325-44.
5 Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009 Jan;121(1):73-85.
6 Girman A, Lee R, Kligler B. An integrative medicine approach to premenstrual syndrome. Am J Obstet Gynecol. 2003 May;188(5 Suppl):S56-65
7 Sherwood RA, Rocks BF, Stewart A, Saxton RS. Magnesium and the premenstrual syndrome. Ann Clin Biochem 1986;23:667–70.
8 Thys-Jacobs S, Starkey P, Bernstein D, et al. Calcium carbonate and the premenstrual syndrome: Effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol 1998;179:444–52.
9 London RS, Sundaram GS, Murphy L, Goldstein PJ. The effect of alpha-tocopherol on premenstrual symptomatology: a double blind study. J Am Coll Nutr 1983;2:115–22.
10 Wyatt KM, Dimmock PW, Jones PW, Shaughn O’Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ 1999;318:1375–81.

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